Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions expressed here are that of the authors and not UBM / Medical Economics.
I have been a practicing urologist in a rural community in Southeast Missouri for 38 years. I used to practice medicine as I was taught in the medical school and residency: When the patient walks into the office, take a detailed history, do a physical examination, obtain indicated laboratory and radiological tests, discuss the possible diagnosis and the therapeutic options with the patient and the family, and treat the disease with appropriate medications and/or procedures as indicated.
However, I later realized that medical practice and treating a patient at the office or in the hospital are not the same. A doctor not only has to treat the organ or organs involved but also address the patient as a whole—his anxiety, psychological status, personal, social, and spiritual factors that may affect the healing process—and communicate with the concerned family members.
The encounter I experienced with a patient few years ago exemplified the above fact and taught me how important it is to spend some time with the patient and the family. The patient should see a friend in his doctor, not a stranger with a white coat and a stethoscope.
Peter Hastings, whose name has been changed to protect his identity, was a 68-year-old gentleman referred to the urology department by his primary care physician for evaluation and management of hematuria, or blood in the urine. The patient was noticing blood stained urine occasionally, but he did not have any difficulty with urination or abdominal pain. His past history was negative for urinary tract infections and kidney stone disease. Physical examination in the office did not reveal any abdominal mass or tenderness. I explained to the patient in detail the implications of blood in the urine, including the possibility of cancer of the urinary tract, and ordered a CT scan of the abdomen and pelvis. I noticed the patient came by himself and did not see any family member with him.
Peter returned two weeks later with the CT scan, and the report revealed a solid mass in the left kidney with high probability of cancer, which might be responsible for the blood in the urine. I sat down with him for a long time and discussed the CT findings, including the fact that there is a solid mass in the left kidney that was most likely cancer, and explained that the best treatment option would be removal of the kidney. Peter looked at me with a so-what look and said, “OK doc, if that is what you think is the best, please go ahead and do it.”
I felt uncomfortable that I did not see any family members with him and asked him, “Peter, is any of the family with you? I would like to discuss the diagnosis and the operation and its complications with the family also.”
“No, they are not here, but it is OK. Please let me know when to come in, and I will be there to have the operation,” Peter tried to reassure me. I was still uncomfortable for I was not able to discuss the situation, including the surgery and its complications, with the family.
On the day of surgery, I saw Peter in the waiting room, talked to him, and explained the surgery to him again. I was surprised as I did not see any family member or friend by his bedside, and I asked him again if anyone accompanied him to the hospital. “No doc, I am OK,” he replied with his usual demeanor.
Peter was taken into the operating room on time and had surgery under general anesthesia. As expected, he had a solid mass on his left kidney with all the features of cancer. A frozen section biopsy of the mass confirmed the diagnosis of renal cell carcinoma, a common type of kidney cancer. The kidney was removed without any major blood loss or complications.